More than 75 physicians from around the state are expected to descend on Columbia today for White Coat Day - an effort by the South Carolina Hospital Association to lobby lawmakers to pass Medicaid expansion.

"If we don't expand Medicaid, South Carolina and the hospitals won't realize the full benefits of the Affordable Care Act," said Rozalynn Goodwin, director of policy research at the Hospital Association.

The federal government has agreed to fund Medicaid expansion under the Patient Protection and Affordable Care Act for three years starting in 2014. After that, states will be required to shoulder some of the burden - eventually 10 percent of the program's cost in 2020. The federal government will continue to fund 90 percent of the cost.

But a 2012 Supreme Court ruling decided the federal government cannot compel states to participate in Medicaid expansion.

That 10 percent match is money South Carolina simply can't come up with, said state Rep. Chip Limehouse, R-Charleston.

"The Affordable Care Act is a bait and switch," Limehouse said. "It breaks the State of South Carolina financially. We're not going to have any part of it."

Limehouse isn't alone. Gov. Nikki Haley, state Medicaid Director Tony Keck and other Republican lawmakers agree that South Carolina can't afford to expand Medicaid.

But the Hospital Association is using White Coat Day to try to convince lawmakers that the state - and the hospital industry in South Carolina - can't afford not to.

"Rural hospitals will be shut down" if the Legislature does not expand Medicaid, predicted Dr. Lloyd Hepburn, an internist at Eagle Landing Adult Medicine in North Charleston, who will participate in White Coat Day.

Hospitals in South Carolina stand to lose billions if the Legislature does not approve expansion, he said, forcing layoffs and possible closures.

Under existing federal law, all hospitals are required to treat patients who seek care at an emergency room - regardless of their ability to pay for those services.

Under the Patient Protection and Affordable Care Act, federal reimbursement payments for that charity care will be cut. Instead, the federal government has agreed to pay for Medicaid expansion. The intent of the law is to offer more patients health insurance, eliminating the need for hospitals to offer the charity care.

"The Medicaid expansion will, once passed, help to buffer our hospitals from those reimbursement cuts that they will receive anyway," Goodwin explained. "Cuts of that magnitude cannot be absorbed without some type of impact on services or employment in our local hospitals."

Dr. Mark Lyles, chief strategic officer at the Medical University of South Carolina, expects the trip to Columbia will be productive.

"It's a great opportunity to interact with politicians," Lyles said. "They are setting the law and making the rules. We can provide them information to make sure those rules maximize the health of all South Carolinians."

Reach Lauren Sausser at 937-5598.